Perversity

No, this is not an update on Republican Senator Larry Craig and the Minneapolis airport bathrooms. This will be a quick post on medical perversity, particularly as it relates to financial incentives for physicians. As I’ve noted before, patients would be mortified if they knew the financial calculations going on inside their doctor’s head when they thought they were devising a treatment plan.

A report published online yesterday in the Journal of the American Academy of Dermatology is an excellent example of perverse financial incentives for doctors. As reported here in the New York Times:

Researchers reported that dermatologists in 12 cities offered a typical wait of eight days for a cosmetic patient wanting Botox to smooth wrinkles, compared with a typical wait of 26 days for a patient requesting evaluation of a changing mole, a possible indicator of skin cancer.

That’s right. We’ll see you right away to smooth those wrinkles, but cancer…sorry…you people have to wait for the next available appointment. The reason, of course, is money. Dermatologists receive $400 to $600 dollars (cash only please) for botox treatments. They receive much less for a mole check (the article reports $50 to $75).

This is a medical example of the hypercompetitive free-market. Remember, in healthcare free-market competition rarely leads to better health outcomes. In fact, perverse financial incentives for doctors frequently lead to worse health outcomes. Over-treatment, excessive testing, unnecessary procedures…but all reimbursable!

I’m not picking on the Dermatologists. Every medical specialty has similar perverse financial incentives (including my own, Internal Medicine). Most doctors I know are conscientious and compassionate. But there are financial factors in play that doctors and patients would be well advised to remember. The desire to maximize profits is powerful.